ABSCESS OF LIVER BURSTING INTO THE PERICARDIUM. By WILLIAM
DYMOCK, Hospital,
Assistant Surgeon to the European
Bombay.
P. E., a German seaman, aged 25, of florid complexion, was admitted into the European General Hospital, Bombay, on the 6th of November, 1865, when he stated that he had been ill three months with cough, pain in the chest, bloody expectoration, and loss of flesh and strength. His history was imperfectly obtained, as he did not understand English well. It appears that the expectoration of blood was preceded by pain in the right side. His state on admission was. dulnesss on the right side, from the third rib down to the hepatic region; no respiratory sounds could be heard over this portion of the chest; on the left side the breathing was peurile ; there was no tenderness on pressure over the hepatic region, but there appeared to be some enlargement of the liver downwards, and towards the left hypochondrium; the sputum was a sanguinolent fluid with greyish white masses of a muco-purulent character floating in it; the quantity varied; some days it was very large, as much as 6 or 8 ounces. The treatment was directed towards checking the bleeding and improving his general health; gallic acid and opium were found of most service in checking the haemorrhage; iron and cod-liver oil were tried, but did not agree. He remained under treatment until the 29th of December, on which date, about noon, after a fit of coughing, sudden collapse occurred. Post Mortem Examination. the chest, the pericardium was observed to be much distended ; it was slit open, and a quantity of pus evacuated ; in the right side of the pericardium, which was much thickened, a stellate rupture was seen which communicated with the right lung; the lower lobe of the right lung and the upper portion of the right lobe of the liver were both firmly incorporated with the diaphragm. On making a longitudinal section through these parts, the following condition was observed, viz.:? The middle and lower lobes of the lung were hollowed out, forming a large cavity with ragged walls and full of pus; from above a number of bronchial tubes communicated with it; the floor of the cavity was formed by the upper part of the great lobe of the liver, and was of firm fibrous structure, and of a saucer-like shape ; beneath this was healthy liver; the diaphragm formed a kind of circular projection round the cavity a little above its floor. The liver was large and vascular, but its structure healthy ; the abscess had been, as it were, thrown off from its uppsr surface. The fibrous septum was half an inch in thickness, and remarkably tough. There was no intestinal lesion.
Upon opening
DYMOCK, Hospital,
Assistant Surgeon to the European
Bombay.
P. E., a German seaman, aged 25, of florid complexion, was admitted into the European General Hospital, Bombay, on the 6th of November, 1865, when he stated that he had been ill three months with cough, pain in the chest, bloody expectoration, and loss of flesh and strength. His history was imperfectly obtained, as he did not understand English well. It appears that the expectoration of blood was preceded by pain in the right side. His state on admission was. dulnesss on the right side, from the third rib down to the hepatic region; no respiratory sounds could be heard over this portion of the chest; on the left side the breathing was peurile ; there was no tenderness on pressure over the hepatic region, but there appeared to be some enlargement of the liver downwards, and towards the left hypochondrium; the sputum was a sanguinolent fluid with greyish white masses of a muco-purulent character floating in it; the quantity varied; some days it was very large, as much as 6 or 8 ounces. The treatment was directed towards checking the bleeding and improving his general health; gallic acid and opium were found of most service in checking the haemorrhage; iron and cod-liver oil were tried, but did not agree. He remained under treatment until the 29th of December, on which date, about noon, after a fit of coughing, sudden collapse occurred. Post Mortem Examination. the chest, the pericardium was observed to be much distended ; it was slit open, and a quantity of pus evacuated ; in the right side of the pericardium, which was much thickened, a stellate rupture was seen which communicated with the right lung; the lower lobe of the right lung and the upper portion of the right lobe of the liver were both firmly incorporated with the diaphragm. On making a longitudinal section through these parts, the following condition was observed, viz.:? The middle and lower lobes of the lung were hollowed out, forming a large cavity with ragged walls and full of pus; from above a number of bronchial tubes communicated with it; the floor of the cavity was formed by the upper part of the great lobe of the liver, and was of firm fibrous structure, and of a saucer-like shape ; beneath this was healthy liver; the diaphragm formed a kind of circular projection round the cavity a little above its floor. The liver was large and vascular, but its structure healthy ; the abscess had been, as it were, thrown off from its uppsr surface. The fibrous septum was half an inch in thickness, and remarkably tough. There was no intestinal lesion.
Upon opening
